An Interesting Frame for Improving Meetings

People often come to meetings with emotions, be they good or bad.  Emotions are often created during meetings (be they good or bad).  Regardless of where the emotions come from, they can derail a meeting.  Or they can make it interesting – in a good way if controlled and managed or a bad way if unbridled).  Therefore part of running a good meeting is recognizing and managing emotions.

Abraham Maslow’s hierarchy of needs offers a frame  for categorizing the emotions that might show up in the meeting room.  The most labile of emotions will come from those who don’t feel safe or secure.  A leader can create safety by using simple “icebreakers”, being genuinely thankful people are there, and/or being clear about the agenda and the process.  Safety is helpful but not sufficient.

A meeting can still get rocky if there is feeling of failure or lack of empowerment (low esteem).  The leader at this point must emphasize recent successes no matter how small.  Remind the group of their purpose and vision.  Be positive and encouraging.  Individuals need to feel confident in their ability to contribute and succeed for a meeting to have optimal participation free of distracting emotions.  Once this need is met, then the leader is ready to address the next hierarchy of need, which is cooperation or sense of belonging.

It’s easy to assume that cooperation exists among a group.  The person facilitating the meeting  may not be aware that there are people in the room who are resentful of one another and/or have lost trust in one another.  If there is lack of cooperation, then time must be devoted to a conversation where differences are discussed, shared values and purpose are mined for and brought to the surface.

The leader may want to remind the group of the diverse strengths people bring to the room, emphasize how working together will bring the best results, and perhaps discuss shared interests.

Those who aren’t feeling part of the group will become disengaged and their negative emotions may impact the effectiveness of the meeting .  Sometimes the work done on gaining cooperation helps, but when it doesn’t, the leader might call on those who might feel on the fringe to provide their thoughts about something, tell a positive story about a recent accomplishment of that individual, or openly praise them for something well done.

Only once the group’s hierarchy of needs have been addressed is the meeting ready to accomplish its goal –  to create new ideas, a new approach, a new way of seeing something, or a new plan.

Once the creating and growing begins its natural for divergence.  The leader’s role is to drive convergence, which can be accomplished by addressing the 5th emotional need in Maslow’s model: the need to be driven by core values and a purpose larger than oneself.  The perfect time to bring back the mission, vision, guiding principles, and shared values of the group.  This will drive them to come to a “final” solution or plan, to reach the goal of the meeting.

Having the results of a meeting wrapped around purpose and meaning gives it energy, which will carry it out of the meeting room and into action.

Adaptive Leadership

It’s been said managers maintain order and leaders change it; the best measure of a leader is the breadth and depth of effective change.  In The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and Your World (HBP 2009) Ronald Heifetz, Alexander Grashow, and Mary Linsky suggest that most leaders aren’t adaptive leaders. They exercise authority, power and/or influence, but not adaptive leadership.

When it comes to technical issues, most leaders demonstrate advanced technical skill.  However, when it comes to adaptive challenges, most leaders fall short, either because they fail to recognize adaptive challenges, they fear the costs of exercising adaptive leadership (e.g. losing their job), or they lack the right tools and tactics (so they fail and lose their job).

A table from The Practice of Adaptive Leadership compares technical leadership to adaptive (Figure 2.3:  Leadership from a position of authority  Figure_2_3 ).

Technical problems often involve managerial intervention and systems engineering. Adaptive challenges often involve people and culture. Technical problems are solved fast by a small group.  Adaptive challenges are dealt with over time and involve many people. Technical problems are well defined and contained.  Adaptive challenges are messy and require framing and reframing.  Technical problems are relatively easy.  Adaptive challenges are hard.

For leaders in healthcare this is a time for adaptive leadership and  technical leadership; too much disruption might threaten access to services and erode quality, but not enough disruption and an organization may fail.  Health care reform is necessary given high costs and less than desirable outcomes. Thus adaptive challenges will continue to surface.

Because adaptive change involves people and culture, and requires courage balanced with consideration, a certain collective leadership capacity across the system is needed to meet adaptive challenges.  The physician workforce as a whole is perceived to be resistant to change, overly protective of our self-interests, and lacking a full perspective on the issues.  If physician leaders communicate unilaterally, listen poorly, and learn slowly, they won’t be effective adaptive leaders.  Adaptive leaders can’t be overly dogmatic know-it-alls.  Rather they must possess the skills to effectively participate in constructive conversations about the need to change, how to change and how to help people cope with the losses that come with change.


Strategic Planning and Hoshin Kanri

In health care we are facing a change in our collective theory of business. Peter Drucker wrote about the need for organizations to test and adjust their theory of business from time to time (HBR 1994). Checking three main assumptions needs to be a regular if not ongoing part of doing business: assumptions about the environment, about the mission of the organization, and about the core competencies needed to achieve success. Drucker suggests that the assumptions in all three areas must fit reality, fit each other, and be constantly tested.   An organization’s theory of business must receive preventive care using two interventions: abandoning parts of the business that are no longer needed for success and studying non-customers. There must also be early diagnosis of holes in the system. One of the early warning signs is unexpected failure. The other warning signs include unexpected success, rapid growth and attaining the current vision. In health care there is no shortage of unexpected failure. Time to check our assumptions.

The concept of strategic planning is well known to most leaders and managers. It’s a process whereby the organization aligns and coordinates its efforts towards the achievement of shared and cascading goals and objectives. This planning is formulated after careful consideration of shifts in the environment, namely competitive and consumer related, but also political and economical. Another important consideration is the gap between current performance and desired performance. And finally, given limited resources and seemingly unlimited possibilities, decisions based on business priorities and values are made, which typically requires guiding principles and a process for decision-making.

Across organizations approaches to planning differ and within organizations the approach may differ from one period to the next. Differences arise from a variety of factors including leader preference, recent events, culture, and whether the last strategic plan was considered a success or a failure. An organization could decide not to have a strategic plan, others might keep it very simple providing just a framework or keep it very focused on one decision, such as a merger or acquisition. Others may choose to get detailed and include tactics and describe specific projects. Regardless, all need to follow the hoshin kanri principles of direction management: 1) focus on shared goals, 2) communicate goals to all leaders, 3) involve all leaders in planning to achieve the goals and 4) hold participants accountable for achieving their part of the plan.  There are two fundamental tools used in the hoshin kanri approach: 1) hoshin tables, and 2) periodic reviews of progress.

The Baldrige Award is typically given to those organizations who are adept at horizontal and vertical deployment of their strategy (DA Garvin HBR 1991).  They have an element of hoshin kanri in their strategic planning and execution .